A New Cervical Spine Clearance Protocol Using Computed Tomography

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Abstract
The purpose of this study was to assess a cervical spine clearance protocol for blunt trauma patients using helical computed tomographic (CT) scan of the cervical spine (C-spine). A protocol using CT scan of the C-spine was implemented and the first 6 months of use reviewed. Patients requiring a CT scan of the head had the C-spine evaluated by lateral C-spine radiography and a helical CT scan. Patients without indication for CT scan of the head had the C-spine evaluated by three-view radiography (anteroposterior, lateral, and odontoid) with selective CT scan of the C-spine for imaging areas not well visualized or those with abnormalities identified by radiography or by clinical examination alone. Three hundred twenty-four patients were admitted to the trauma center after blunt trauma during the first 6 months of protocol implementation. Head CT scans were obtained in 158 patients and lateral cervical spine radiography in conjunction with helical CT scanning evaluated the C-spine. The other 166 patients had the cervical spine cleared by three-view radiography series or by clinical examination alone. For patients in whom a head CT scan was not indicated, CT scanning was used only when plain radiographs failed to adequately visualize the entire C-spine. A total of 15 injuries (4.6% of the group) were detected. Seven injuries were suspected or detected by lateral plain radiographs and confirmed by CT scan. Six patients had an injury not detected by radiography but diagnosed by CT scan, and one patient had a false-positive radiograph. Of the remaining two injuries, one was diagnosed by magnetic resonance imaging and the other by CT scan outside of the protocol. Lateral plain radiographs alone failed to detect 46% (n = 6) of all injuries. In our series, the selective use of helical CT scanning with plain radiography increased the accuracy with which cervical spine injury was detected from 54% to 100%. The protocol allowed for more rapid evaluation in many patients as well. We recommend that practice guidelines include the use of helical CT scan of the entire C-spine as the diagnostic procedure for those blunt trauma patients undergoing CT scanning of the head.